U.S. hospitals ignore improving elder care. That’s a mistake

Elder patients in the U.S. often end up in older hospitals and medical centers. That usually means long walks down halls without railings or chairs with arms for rest stops. FRED DUFOUR/AFP/Getty Images

Sick children deserve optimal medical care. So why were my colleagues and I saddened by a California midterm ballot initiative aimed at doing just that?

Like the majority of Californians, I voted for the initiative to authorize $1.5 billion in bonds in grants for the “construction, expansion, renovation, and equipping of qualifying children’s hospitals.” Voting “yes” was the socially responsible, compassionate choice. My chagrin came not from what the measure will do for our state but from what is missing in health care funding — not just in California, but across the nation.

Given the vast number of children who have died throughout most of human history (in 1900, 30 percent of all deaths in the United States occurred in children less than 5 years of age), we are fortunate to live at a time when most children are healthy and live into adulthood and beyond. While children and adolescents make up 23 percent of the U.S. population, they account for only 16 percent of hospitalizations, mostly in the first year of life. If you exclude infants, individuals under age 18 make up just 4 percent of hospitalizations.

Thanks to 20th-century advances in public health and medicine, a majority of Americans now live into elderhood. More children today benefit from education bonds than health care bonds. Yet our policies and priorities are still directed at century-old needs and demographics.

In the 21st century, health care is to elderhood as education is to childhood. But we don’t see bond measures for the “construction, expansion, renovation, and equipping” of hospitals to optimize care of old people, an investment that would surely benefit Americans of all ages.

People age 65 and older make up just 16 percent of the U.S. population but nearly 40 percent of hospitalized adults. In 2014, Americans over age 74 had the highest rate of hospital stays, followed by those in their late 60s and early 70s.

Remarkably, hospitals aren’t designed with elders in mind. Walk through one and you’ll almost invariably find cheerful decor for children, services and facilities aimed at adults, and a gauntlet of obstacles and insults to elders.

At most hospitals and medical centers, the newest buildings focus on cancer, neuroscience, children, and research. Old people end up in old buildings. That usually means long walks down halls without railings or chairs with arms for rest stops. It means signs that are hard to read until you are right under them. It means a one-size-fits-all approach to both facilities and care that doesn’t acknowledge that the needs, preferences, and realities of a 75- or 95-year-old with a medical condition might differ from those of a 35- or 55-year-old with the same thing.

It’s the rare industry that doesn’t target and cater to its best customers. Health care not only fails to cater to elders, it fosters system-wide injustice by failing to apply the same standards to elderhood that it applies to childhood and adulthood. Just as children’s hospitals have been shown to save and better the lives of children, hospital wards, services, and emergency departments aimed at elders improve their care and lives when compared to adult-centric facilities.

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U.S. hospitals ignore improving elder care. That’s a mistake